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Pharm II-Exam 3 > Gout > Flashcards

Gout Flashcards

1
Q

Risk of gout is defined as what level of uric acid in women?

A

> 7 mg/dL

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2
Q

Risk of gout is defined as what level of uric acid in men?

A

> 6 mg/dL

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3
Q

What accounts for 90% of the reason/pathophys for gout in pt’s?

A

Underexcretion of uric acid:

Relative decrease in renal excretion of uric acid for an unknown reason=Primary Idiopathic hyperuricemia

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4
Q

List high and moderately high purine rich foods (5-100 mg/3.5 oz serving)

A
  1. Meats: beef, seafood

2. Fast-growing vegetables: spinach, asparagus

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5
Q

List very high purine rich foods (1,000 mg/3.5 oz serving)

A

Anchovies
Organ meats
Sardines

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6
Q

How much purines does the average daily US diet contain?

A

600-1,000 mg

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7
Q

List the drugs that can induce hyperuricemia

A
  1. Cytotoxic drugs
  2. Cyclosporine
  3. Diuretics
  4. Ethanol
  5. Ethambutol
  6. Levodopa
  7. Nicotinic acid
  8. Pyrazinamide
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8
Q

How long does an acute gout attack last for?

A

3-10 days

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9
Q

List the two components of chronic gout

A
  1. Rheumatoid-like

2. Tophaceous Gout: Monosodium urate in soft tissues and joints

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10
Q

What is the definitive diagnosis for gout?

A

Tapping joint and microscopic exam for uric acid crystals

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11
Q

List the anti-inflammatory of choice in the treatment of gout

A

DMARDs

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12
Q

List the treatment for acute gout

A
  1. NSAIDs

2. Corticosteroids

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13
Q

List the treatment for chronic gout

A
  1. Colchicine
  2. Probenicid (uricosuric)
  3. Allopurinol, febuxostat: xanthine oxidase inhibitors
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14
Q

Colchicine MOA

A
  1. Decreases macrophage migration and phagocytosis

2. Inhibits leukotriene B4=Decreases inflammation

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15
Q

When does Colchicine need to be administered?

A

Within 36 hrs. of acute attack onset

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16
Q

Colchicine dosing

A

1.2 mg followed by 0.6 mg in 1 hr

17
Q

Colchicine ADE’s

A

Dose-dependent GI ADE’s: N/V/D

18
Q

When is dose adjustment recommended in Colchicine?

A

When used with:

  1. Selected CYP3A4
  2. P-glycoprotein inhibitors
19
Q

List the oral form of corticosteroids used in gout

A

Oral Methylprednisolone dose pack

20
Q

List the IM form of corticosteroids used in gout

A

IM Triamcinolone: to be followed by oral prednisone or prednisolone

21
Q

When would you consider using intra-articular (TAC-Kenalog) administration?

A

Only 1-2 joints are involved

Used in combo with NSAIDs, Colchicine or oral corticosteroids

22
Q

What type of medications are needed during the initiation of rate-lowering therapy? for how long?

A

Anti-inflammatories:
@ least 6 months OR
3-6 months after achieving target serum uric acid

23
Q

What are the anti-inflammatory options during the initiation of rate-lowering therapy

A
  1. Colchicine 0.6 mg 1-2x daily
  2. Low dose NSAIDs w/ PPI
  3. Prednisone <10 mg/day
24
Q

What is efficacious for the prophylaxis of recurrent gout attacks in BOTH underexcreters and overprices of uric acid?

A

Xanthine Oxidase Inhibitors (XOI):

  1. Allopurinol
  2. Febuxostat
25
Q

What are the indications for initiating Allopurinol or Febuxostat (XOI’s)

A
  1. 2 or more gout attack per year
  2. 1 or more tophus
  3. CKD (stage II or worse)
  4. Hx urolithiasis
26
Q

What ADE do you want to educate your patients about when using Allopurinol?

A

Acute Hypersensitivity Syndrome (AHS)

27
Q

What high risk populations (for AHS) do you consider genetic testing in?

A
  1. Koreans w/ CKD

2. Han Chinese and Thai irrespective of renal function

28
Q

Allopurinol MOA

A

IRREVERSIBLY inhibits xanthine oxidase=lowers uric acid production

29
Q

Febuxostat MOA

A

REVERSIBLE inhibitor of xanthine oxidase

30
Q

Febuxostat is CI with the use of what?

A

Azathioprine

31
Q

Febuxostat ADE

A

Liver enzyme elevation

32
Q

Febuxostat toxicities

A
  1. Liver function test
  2. Renal function

*BUT NO dose adjustments in pt’s with mild/mod renal (CrCL 30-89) or hepatic impairment

33
Q

What is the effect of Probenecid?

A

Increase uric acid excretion

34
Q

What is the benefits and considerations in using XOI + Fenofibrate or losartan?

A
  1. Augments uric acid excretion

2. Beneficial in pt’s with other disorders

35
Q

When would you consider using for refractory gout to conventional therapy?

A

Pegloticase= Biologic

36
Q

What must you use with Lesinurad? Why?

A

Combo w/ XOI’s d/t increased risk of acute renal failure with mono therapy

37
Q

List the Interleukin-1 Inhibitors and indications for them

A

Anakinra
Rilonacept
Canakinumab

ACUTE gout
Refractory to traditional therapy
CI to current tx’s

Pharm II-Exam 3 (4 decks)

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